posted May 11, 201117:37
Associated PressSAN FRANCISCO - Noting that an average of 18 veterans a day commit suicide, a federal appeals court on Tuesday ordered the Department of Veterans Affairs to dramatically overhaul its mental health care system.

In the strongly worded ruling, the 9th U.S. Circuit Court of Appeals said it takes the department an average of four years to fully provide the mental health benefits owed veterans.The court also said it often takes weeks for a suicidal vet to get a first appointment.

The "unchecked incompetence" in handling the flood of post-traumatic stress disorder and other mental health claims is unconstitutional, the court said.

"No more veterans should be compelled to agonize or perish while the government fails to perform its obligations," Judge Stephen Reinhardt wrote for the three-judge panel. "Having chosen to honor and provide for our veterans by guaranteeing them the mental health care and other critical benefits to which they are entitled, the government may not deprive them of that support through unchallengeable and interminable delays."

The VA could ask the appeals court to reconsider its decision with a special 11-judge panel; ask the U.S. Supreme Court to take the case; or abide by the ruling.

The court said one of every three soldiers returning from Iraq and Afghanistan was treated by the VA for mental health issues, including post-traumatic stress syndrome. A 2008 Rand Institute study found that 18.5 percent of soldiers returning from those countries were diagnosed with PTSD, and the study concluded 300,000 soldiers currently deployed suffer from it or major depression.

The 9th Circuit ruling overturned a 2008 verdict by U.S. District Judge Samuel Conti. After a two-week trial, Conti ruled that a lawsuit filed by two veterans groups seeking a judicial order for an overhaul of the VA was misdirected.

Conti said he was powerless to act because Congress narrowly limited the authority courts have in reviewing VA benefit decisions.

Conti didn't find a system-wide crisis in which health care is not being provided within a reasonable time to the roughly 5 million veterans enrolled in the VA's health care system, which includes 153 hospitals and 800 clinics.

The appeals court, however, said there's ample evidence the VA is falling down in its duty to provide timely care for the mental health needs of the country's military veterans.

"The delays have worsened in recent years, as the influx of injured troops returning from deployment in Iraq and Afghanistan has placed an unprecedented strain on the VA, and has overwhelmed the system," Reinhardt wrote.

The court said a 2007 report by the Office of the Inspector General found significant delays in timely referrals from VA doctors for treatment of PTSD and depression. Fewer than half of the patients received same-day mental evaluations, while others had to wait as long as two months for a counseling session.

"These extensive waiting times can have devastating results for individuals with serious mental illnesses," Reinhardt wrote. He was joined by Judge Proctor Hug.

The appeals court sent the case back to Conti in the trial court and ordered him to work with the VA and the veterans groups toward a new mental health care plan that implements a speedier process to appeal denied benefits, provides timely mental health treatment and ensures suicidal vets are seen immediately.

If the VA fails to come up with an acceptable plan, the appeals court told Conti to fashion his own plan. Conti scheduled a court hearing for May 27.

"The majority hijacks the Department of Veterans Affairs mental health treatment and disability compensation programs and installs a district judge as reluctant commander-in-chief," Kozinski wrote

Paul Sullivan, executive director of Veterans for Common Sense, which filed the lawsuit along with Veterans United for Truth, said vets had their day in court and won.

"Now we urge VA to move forward so no veteran is delayed or denied health care or disability benefits," he said

During the two-week trial without a jury in April 2008, lawyers for the groups showed the judge e-mails between high-ranking VA officials confirming high suicide rates among veterans and a desire to keep quiet the number of vets under its care who attempt suicide.

"Shhh!" began a Feb. 13, 2008, e-mail from Dr. Ira Katz, a VA deputy chief. "Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?"

Katz wrote in another e-mail that 18 veterans kill themselves daily on average.

After the trial, another e-mail surfaced that was written by VA psychologist Norma Perez suggesting that counselors in Texas make a point to diagnose fewer post-traumatic stress disorder cases. The veterans' lawyers argued that e-mail showed the VA's unwillingness to properly treat mental health issues.

It was one of the biggest efforts ever to open a hospital system to public scrutiny — and it held some cause for embarrassment to the Kansas City VA Medical Center.

Buried in the gush of hospital quality and safety data that began pouring from the Department of Veterans Affairs website last fall was a startling statistic: The number of deaths among surgery patients at the Kansas City hospital was 79 percent higher than what was expected.

That percentage was the highest of any full-service hospital in the VA system. It prompted the hospital to investigate and make changes.

By compiling data on patients, making it public and holding administrators’ feet to the fire when numbers don’t turn in the right direction, the VA is trying to prod improvement at its 150-plus hospitals.

“We’re trying to drive performance improvement. Even our best hospitals have areas where they can be better,” said William Duncan, the VA’s associate deputy undersecretary for health quality and safety.

Hospitals with high death rates that don’t improve fast enough are subject to progressively more intense reviews.

“We have had hospital directors offered the opportunity to succeed elsewhere out of the VA if they don’t do better,” Duncan said.

The VA system has taken its licks over the years for substandard health care. In 2002, Congress investigated sanitation problems at the Kansas City hospital after maggots were found in the noses of two comatose patients. Last week, members of Congress from both parties lashed the VA for lapses in equipment sterilization at several hospitals.

But by many measures, the VA now equals or surpasses the civilian sector for quality. A study published in March found that the VA’s care of seniors was consistently better than that offered by private Medicare Advantage plans.

And a study in April reported that VA hospitals had reduced intensive care unit infections with antibiotic-resistant MRSA bacteria by 60 percent.

The Kansas City hospital has been MRSA-free for the past year.

Because it is run by the government, the VA comes under more public scrutiny than private hospitals do, said Ashish Jha, a Harvard expert on health care quality who is also a practicing physician with the VA in Boston.

That can give the appearance that VA hospitals have more than their share of problems.

“Mistakes happen throughout health care, but there’s much less transparency in the private sector,” Jha said. “I have no reason to believe mistakes are happening more often at the VA. Taken as a whole, it’s a place that offers pretty good care.”

The VA did away with much of its paperwork years ago and replaced it with electronic medical records. The system can track in detail the condition patients were in when they arrived at the hospital, treatments they received and how they fared.

Several years ago, the VA started putting its databases together so that hospitals could more easily see how they were doing.

But the information wasn’t making it to the public.

That changed when retired Army general Eric Shinseki became President Barack Obama’s secretary of veterans affairs.

“Our secretary has been absolutely resolute, firm that we be transparent with our safety and quality data,” Duncan said.

Medicare had been putting quality information about hospitals on its Hospital Compare website for years. But the VA wasn’t participating.

Shinseki directed the VA to contribute its data. VA hospitals started appearing on the Medicare site in March 2010.

But Shinseki wasn’t satisfied. He ordered the VA to create its own hospital compare site with more data than Medicare offers. It went live in November.

“Medicare is trying to catch up, but it’s not anywhere close to what the VA is doing,” Jha said.

In color-coded charts, the VA’s site shows how close hospitals are to meeting the system’s quality goals, from curbing infections to keeping blood sugar down in diabetes patients to making sure heart attack patients get the right treatments.

“This sets very, very rigorous performance goals,” said Peter Almenoff, VA assistant deputy undersecretary for health quality and safety, based in Kansas City. “We didn’t want to create a system that just says we’re wonderful.”

The VA set many of the standards itself because none existed in the private sector.

“If you go to any other health system, you won’t see anything like this,” Almenoff said.

Another set of data the VA has made public shows how the number of patient deaths at each hospital compares with the number expected for acute care, intensive care and surgery.

That data triggered the investigation at the Kansas City VA Medical Center.

Sanders, the hospital’s chief of staff, said the hospital didn’t find any particular surgeon or procedure that bumped up the mortality rate.

But patients with serious underlying health problems who weren’t likely to live longer by getting surgery were ending up on the operating table.

For some of these patients, palliative care to make them more comfortable would have been an appropriate alternative.

Sanders said the hospital has increased its surgical staffing and is looking at ways to improve patient counseling about palliative care.

Jha, the Harvard hospital quality expert, said the high surgery mortality at the Kansas City VA should be kept in perspective. Its other quality data don’t suggest major problems.

“When you look at lots and lots of data, you will always find something that sticks out from normal,” Jha said. “I would feel comfortable saying from the totality of the data, things look pretty good.”

But Kansas City still needs to fix whatever was wrong with its surgery program, Jha said.

“If they say there’s nothing to fix, that’s a problem,” he said. “It will be really important to see what happens next if in the next six or 12 months things are trending down.”

posted May 11, 201119:10
I also just wanted to say from that post that I have a lot of respect for General Shinseki. First of all he called it on the Iraq war and the Bush admin brushed him and Colin Powel aside in the end. I was pissed. Shinseki developed the Stryker brigades, has a bronze star, purple heart, airborne, ranger tab, etc.

I think he is busting up the VA and transforming it into a more modern system that provides better care.

--------------------It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so.Posts: 6947 | Registered: Apr 2004
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quote:Originally posted by IWISHIHAD: Getting away from the issues with the VA, why are there so many suicides happening with this era of combat veterans?

They have a lot better care(PTSD Etc.) than privious era combat vets, yet it appears they are committing suicide at an alarming rate to me.

Is it issues with jobs etc. when they return?

Again as we have said many times over the years on this board, we have to think very hard before we commit our troops to combat.

This is just another reality of the long term affects of war on our young soldiers!

What a shame, so many young lives.

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Social media and communication has greatly increased. Many more men are getting divorce papers scanned and mailed to them while they are in combat zones. They can get online during their downtime and get an email from their wives saying they left them/cheating. Thats what I saw the cause of all suicides. Not really THAT much different, but coming home for a lot of guys is really hard when you are greeted with divorce after losing close friends.
Posts: 6947 | Registered: Apr 2004
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"Social media and communication has greatly increased. Many more men are getting divorce papers scanned and mailed to them while they are in combat zones. They can get online during their downtime and get an email from their wives saying they left them/cheating. Thats what I saw the cause of all suicides. Not really THAT much different, but coming home for a lot of guys is really hard when you are greeted with divorce after losing close friends. "

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Nothing new there much faster communication but the same old thing, soldiers have always had to deal with that, especially since the sixties.

Combat soldiers in general do have much more down time these days from what i have heard compared to other wars, but a lot of the suicides are coming at home.

Wonder if there is a lot more frustration because of the rules that have to be followed within and closely around these cities and farming areas, tend to take that with you more.

Had some in other wars but i am sure not to the extent they do these days.

Hard to get fired upon and have to constantly decide between the good and the bad guys, especially when your guys go down.

Again we know the knowledge and care is much better these days for PTSD and other mental problems, thus there should be much less in suicidal rates.

Has to be other things pushing them over the edge that were not factors in other wars.

posted May 12, 201112:17
when i was in the navy? the enlisted club was where all the wives went when the ships left port, it is a complete lifestyle.....

that was one of the reasons i decided not to make a career in the navy, i just wasn't interested in that lifestyle...

i knew guys that lived in base housing who actually had to tell men to leave their wives and their homes (and kids) when they came back from deployment, some never bothered, they just moved back with them ...

while i would not say it is the "norm" in the navy, it was very common, esp amongst people on their second enlistment and further.

you have to realise that in the navy if you are not married? you live on the ship and there is no money made available to you for off base housing. rarely can you afford your own place even at E5 pay, you still cannot save money and have home. so marriages tend be lifestyle contracts because you get way mo'money...

as to the suicide issues? my take on depression is that it tends to be anger turned inward.

i am not up on the treatmetns for PTSD but i have done alot of reading on all these new anti-depression drugs.. almost all of them are clearly labeled that they can actually cause suicidal thoughts. IMO that is because they are geared to increase mental and physical activity. Depression tends to cause people to be inactive,whihc is a good thing cuz if you are angry at yourself, you should not feel energetic enough ot actually do anything about it. these drugs are "facilitators" in the sense that they are intended to make you pro-active. Usually that would help many people to "get going" again and shake off depression, but in some cases the "getting going again" is activated in the wrong direction...

war is hell. living on adrenalin is addictive and withdrawing that adrenalin can act very differntly on differnt people.

posted May 12, 201112:37
sadly, these drugs are often prescribed in lieu of pain killers. like i said i have no idea waht the treatment protocols are that the VA uses, but i doknow that many people seem to react the "opposite" of what is intended with the drugs. on th eother hand, many people do get significant releif form them, so when the patient does not effectively communicate that the drug is not working as expected, they can bein seriuos trouble real fast. i am not willing to say that the drugs are bad, just that the patients need to be monitored carefully and VA needs more resources. We cannot do enough fro them, and we asked them to do it all for US.

posted May 12, 201113:50
The really sad part of this whole issue is that combat vet kids have a much higher rate of suicide than the rest of the population, at least that was the case several years ago.

To many vets passing their problems on to their kids.

Not easy for parents not to pass on their problems, but they should think very carefully before they talk or act so as to keep their kids as far away from the problem as possible, not and easy task of what to share with kids and what not to share.